Use of nighthawk services fails to match expectations

Contrary to concerns about teleradiology encroachment, a Yale University survey finds that use of external after-hours services accounts for a small percentage of radiology practices' total interpretations. Interpretation by foreign-trained radiologists is not widespread.

The survey, published in the June issue of the Journal of the American College of Radiology, sheds light on some issues that have worried radiologists, said Adam H. Kaye, a member of the research team from Yale University School of Medicine. The lead investigator was Jonathan H. Sunshine, the American College of Radiology's director of research.

"With many options for using the services - in terms of payment structure, coverage times, and volume of studies sent - we wanted to see, from a practice's perspective, exactly how these services are being used, and to what extent," Kaye said of results from the Yale/ACR-funded survey.

Between August of 2005 and June of 2006, researchers randomly selected 300 nonspecialty hospitals from the 2005 American Hospital Association directory. They obtained 115 responses from radiology chiefs, including 64 from practices that used an external after-hours service.

Practice managers gave convenience as the top reason they use nighthawk services, with value for recruiting ranked second and shortage of radiologists for off-hours coverage ranked third.

Three-fourths of practices said they receive 5% or less of their reads from offsite companies. Two-thirds said they paid as much as they collected for the service, and about 40% used a teleradiology company located outside the U.S. More than half said that the radiologists reading internationally were either all or mostly from the U.S., while 40% did not know the proportion. In-state licensure of all interpreting teleradiologists is essentially universal, according to the study.

Surprisingly, 39% of the practices surveyed said they get some help in paying for the after-hours service from their hospital.

"I think it will be interesting to see if this number goes up or down, as the competitive climate for both after-hours services and radiology practices themselves becomes more intense,'' Kaye said.